Application of whole-process exercise management based on COM-B theory in patients recovering from stable chronic heart failure
Objective To explore the application effects of continuous exercise management based on capacity,opportunity,motivation-behavior(COM-B)theory in patients with stable chronic heart failure using a telemedicine platform.Methods A continuous exercise management intervention program based on COM-B theory was formulated through literature review and Delphi expert consultation.Seventy-two patients with chronic heart failure admitted to Hebei Provincial People's Hospital from September 2023 to March 2024 were selected as the study subjects.They were randomly divided into control group(36 cases)and experimental group(36 cases)using a random number table.The control group received conventional discharge exercise guidance and health education,while the experimental group received continuous exercise management intervention guided by COM-B theory in addition to what the control group received.Before the intervention and at 4 weeks and 12 weeks after the intervention,evaluations were conducted using left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),the 6-minute walking test,the exercise self-efficacy scale,and the heart failure quality of life questionnaire.Results In this study,three patients from the control group and one patient from the experimental group were lost to follow-up.The overall analysis showed that there were statistical significances in comparison between groups,comparison at time points and interaction between the two groups of cardiac function(P＜0.05).Further pairings and intra-group comparison:LVEF at 4 weeks of intervention was higher than before intervention,LVEDD was lower than before intervention,LVEF at 12 weeks of intervention was higher than 4 weeks of intervention,LVESD and LVEDD were lower than 4 weeks of intervention(P＜0.05).Intergroup comparison:after 12 weeks of intervention,LVEF of experimental group was higher than that of control group,LVESD and LVEDD were lower than that of control group(P＜0.05).Overall analysis found that there were statistically significant differences in comparison,time point comparison and interaction between the two groups of 6-minute walking test groups(P＜0.05).Further pairwise comparison,intra-group comparison:after 4 weeks of intervention,6-minute walking distance in both groups was higher than before intervention,and after 12 weeks of intervention was higher than after 4 weeks of intervention(P＜0.05).Intergroup comparison:after 12 weeks of intervention,the experimental group was higher than the control group(P＜0.05).The overall analysis showed that there were statistically significant differences in the comparison,time point comparison and interaction between the two groups of exercise self-efficacy(P＜0.05).Further pairwise comparison,intra-group comparison:after 4 weeks of intervention,the scores of exercise self-efficacy in both groups were higher than before intervention,and after 12 weeks of intervention were higher than after 4 weeks of intervention(P＜0.05).Intergroup comparison:after 12 weeks of intervention,the experimental group was higher than the control group(P＜0.05).The overall analysis showed that there were significant differences in the minnesota living with heart failure questionnaire of life between the two groups(among other areas),time point comparison and interaction(P＜0.05).Further pairwise comparison,intra-group comparison:the control group was lower than before intervention in physical areas,other areas and total score after 4 weeks of intervention,the experimental group was lower than before intervention in all dimensions and total score after 4 weeks of intervention,and after 12 weeks of intervention was lower than after 4 weeks of intervention(P＜0.05).Intergroup comparison:after 12 weeks of intervention,the experimental group was lower than the control group(P＜0.05).Conclusion Continuous exercise management based on COM-B theory has a good application effect on the rehabilitation of patients with stable chronic heart failure.It can effectively improve cardiopulmonary function,exercise self-efficacy,and improve the quality of life.
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